Genomic and phenotypic studies among Clostridioides difficile isolates show a high prevalence of clade 2 and great diversity in clinical isolates from Mexican adults and children with healthcare-associated diarrhea.

Clostridioides difficile (C. difficile) is widely distributed in the intestinal tract of humans, animals, and in the environment. It is the most common cause of diarrhea associated with the use of antimicrobials in humans and among the most common healthcare-associated infections worldwide. Its pathogenesis is mainly due to the production of toxin A (TcdA), toxin B (TcdB), and a binary toxin (CDT), whose genetic variants may be associated with disease severity. We studied genetic diversity in 39 C. difficile isolates from adults and children attended at two Mexican hospitals, using different gene and genome typing methods and investigated their association with in vitro expression of toxins. Whole-genome sequencing in 39 toxigenic C. difficile isolates were used for multilocus sequence typing, tcdA, and tcdB typing sequence type, and phylogenetic analysis. Strains were grown in broth media, and expression of toxin genes was measured by real-time PCR and cytotoxicity in cell-culture assays. Clustering of strains by genome-wide phylogeny matched clade classification, forming different subclusters within each clade. The toxin profile tcdA+/tcdB+/cdt+ and clade 2/ST1 were the most prevalent among isolates from children and adults. Isolates presented two TcdA and three TcdB subtypes, of which TcdA2 and TcdB2 were more prevalent. Prevalent clades and toxin subtypes in strains from children differed from those in adult strains. Toxin gene expression or cytotoxicity was not associated with genotyping or toxin subtypes. In conclusion, genomic and phenotypic analysis shows high diversity among C. difficile isolates from patients with healthcare-associated diarrhea. IMPORTANCE: Clostridioides difficile is a toxin-producing bacterial pathogen recognized as the most common cause of diarrhea acquired primarily in healthcare settings. This bacterial species is diverse; its global population has been divided into five different clades using multilocus sequence typing, and strains may express different toxin subtypes that may be related to the clades and, importantly, to the severity and progression of disease. Genotyping of children strains differed from adults suggesting toxins might present a reduced toxicity. We studied extensively cytotoxicity, expression of toxins, whole genome phylogeny, and toxin typing in clinical C. difficile isolates. Most isolates presented a tcdA+/ tcdB+/cdt+ pattern, with high diversity in cytotoxicity and clade 2/ST1 was the most prevalent. However, they all had the same TcdA2/TcdB2 toxin subtype. Advances in genomics and bioinformatics tools offer the opportunity to understand the virulence of C. difficile better and find markers for better clinical use.

[Retinal alterations detected by non-mydriatic retinal camera screening and referral to ophthalmology in a population with high cardiovascular risk]. / Alteraciones retinianas detectadas por screening con cámara retinal no midriática y derivación a oftalmología en una población de alto riesgo cardiovascular.

OBJECTIVE: To describe the main retinal alterations detected by non-mydriatic retinal camera screening and to evaluate factors related to referral to ophthalmology in a population at high cardiovascular risk in Palmira, Colombia. MATERIALS AND METHODS: Cross-sectional observational study, which included 11,983 photographic imaging records of patients with hypertension and diabetes mellitus from Gesencro's S.A.S. comprehensive chronic disease care program between 2018 and 2020. Risk factors associated to referral to ophthalmology were evaluated with logistic regression, and crude and adjusted ORs (odds ratios) were obtained. RESULTS: A total of 11,880 records were analyzed; 67.7±12years old, and 69.5% were women. Among the retinal alterations were patients with diabetic retinopathy classified as more than mild in 10% and gradeI hypertensive retinopathy in 54.9% right eye, 51.9% left eye. Macular edema was also identified. Only 2069 patients (17.4%) required referral to ophthalmology, and for imaging control 82.6%. In the multivariate analysis, the risk factors associated with the probability of being referred were male gender, age 60years and older, glycosylated hemoglobin out-of-target, advanced chronic kidney disease and the microalbumin-to-creatinine ratio moderate to severely elevated. CONCLUSION: This study makes it possible to determine the importance of screening with a non-mydriatic retinal camera in patients at high cardiovascular risk to detect retinal abnormalities and assess risk factors associated with referral to ophthalmology. Early documentation of ocular compromise in these patients could prevent and avoid visual impairment and blindness.

Factores asociados al control de síntomas nucleares en pacientes pediátricos con trastorno de déficit de atención e hiperactividad, en un centro especializado de Medellín entre 2018 y 2019 / Factors associated with the control of nuclear symptoms in pediatric patients with Attention Deficit Hyperactivity Disorder in a specialized center in Medellín between 2018 and 2019 / Fatores associados ao controle de sintomas nucleares em pacientes pediátricos com transtorno de déficit de atenção e hiperatividade, em um centro especializado em Medellín entre 2018 e 2019

Objetivo: el trastorno de déficit de atención e hiperactividad (TDAH) ha sido descrito como el trastorno del neurodesarrollo más común en la infancia. Esta condición se asocia a un significativo deterioro en calidad de vida, múltiples comorbilidades y, a largo plazo, a menores logros académicos y laborales. A pesar de que se ha evidenciado que en los pacientes de ascendencia latina se presenta un posible subdiagnóstico, que en Colombia se han estimado prevalencias mayores a las descritas en el planeta, y que los efectos de la pandemia por Covid-19 han podido exacerbar esta problemática, el volumen de estudios con estimaciones reproducibles sobre las características, tratamientos recibidos y control de síntomas de estos pacientes aún requiere ampliarse. Este estudio busca establecer los factores sociodemográficos, clínicos y del tratamiento asociados al control de los síntomas nucleares de este trastorno, que consisten en patrones persistentes y generalizados de inatención, impulsividad e hiperactividad. Metodología: estudio descriptivo con intención analítica en una cohorte retrospectiva de pacientes pediátricos con trastorno de déficit de atención e hiperactividad seguidos durante seis meses en un centro especializado de Medellín, Colombia, entre 2018 y 2019. Resultados: se identificó una incidencia de control de síntomas de 46,7% que se asoció de manera significativa con la adherencia al tratamiento y con historia familiar de TDAH. Conclusiones: puede afirmarse que, en pacientes pediátricos con TDAH, estos factores podrían aumentar la probabilidad de lograr el control de los síntomas nucleares.

Objective: Attention Deficit Hyperactivity Disorder (ADHD) has been described as the most common neurodevelopmental disorder in childhood. This condition is associated with significant deterioration in the quality of life, multiple comorbidities and, in the long term, lower academic and work achievements. Despite the fact that it has been shown that patients of Latin descent present a possible underdiagnosis, that in Colombia higher prevalence has been estimated than those described worldwide, and that the effects of the Covid-19 pandemic have been able to exacerbate this problem, the volume of studies with reproducible estimates on the characteristics, treatments received, and symptom control of these patients still needs to be expanded. This study seeks to establish the sociodemographic, clinical and treatment factors associated with the control of the core symptoms of this disorder, which consist of persistent and generalized patterns of inattention, impulsivity and hyperactivity. Methodology: Descriptive study with analytical intent in a retrospective cohort of pediatric patients with attention deficit hyperactivity disorder followed up for 6 months in a specialized center in Medellín, Colombia, between 2018 and 2019. Results: An incidence of symptom control of 46.7% was identified, which was significantly associated with adherence to treatment and with a family history of ADHD. Conclusions: It can be affirmed that, in pediatric patients with ADHD, these factors could increase the probability of achieving control of nuclear symptoms.

Objetivo: o transtorno dedéficit de atenção e hiperatividade (TDAH) tem sido descrito como o transtorno do neurodesenvolvimento mais comum na infância. Esta condição está associada a uma deterioração significativa na qualidade de vida, múltiplas comorbidades e, a longo prazo, menores rendimentos acadêmicos e profissionais. Apesar de ter sido demonstrado que os pacientes de ascendência latina apresentam um possível subdiagnóstico, e que na Colômbia foram estimadas prevalências mais altas do que as descritas no planeta e que os efeitos da pandemia de Covid-19 foram capazes de exacerbar esse problema, o volume de estudos com estimativas reprodutíveis sobre as características, tratamentos recebidos e controle de sintomas desses pacientes ainda precisam ser ampliados. Este estudo busca estabelecer os fatores sociodemográficos, clínicos e de tratamento associados ao controle dos sintomas centrais desse transtorno, que consistem em padrões persistentes e generalizados de desatenção, impulsividade e hiperatividade. Metodologia: estudo descritivo com intenção analítica em uma coorte retrospectiva de pacientes pediátricos com transtorno de déficit de atenção e hiperatividade acompanhados por seis meses em um centro especializado em Medellín, Colômbia, entre 2018 e 2019.Resultados: identificou-se uma incidência de controle dos sintomas de 46,7%, signifi-cativamente associada à adesão ao tratamento e ao histórico familiar de TDAH.Conclusões: Pode-se afirmar que, em pacientes pediátricos com TDAH , esses fatores podem aumentar a probabilidade de controle dos sintomas nucleares.

In vitro ovicidal activity of Brongniartia montalvoana against small ruminant gastrointestinal nematodes.

Several plants of the Fabaceae family have been assessed regarding their high nutritional value and anthelmintic properties. The ovicidal effect of the hydroalcoholic extract (Bm-HAE) and subfractions from the aerial parts of Brongniartia montalvoana (Fabaceae) against a mixed strain of gastrointestinal nematodes (GIN) (Haemonchus spp., Trichostrongylus spp. and Oesophagostomum spp.) resistant to albendazole sulfoxide, ivermectin and levamisole was evaluated by the egg hatch test (EHT). The Bm-HAE was subjected to liquid-liquid chemical separation with ethyl acetate giving two fractions, an aqueous (Bm-Aq) and an organic (Bm-EtOAct). The purification of the bioactive fraction (Bm-EtOAct) through chromatographic separation resulted in four bioactive subfractions (BmR6, BmR7, BmR8 and BmR10). The treatments were designed as follows: Bm-HAE at 800, 1,500, 3,000 and 6,000 µg/mL, and Bm-Aq, Bm-EtOAct and subfractions (BmR6, BmR7, BmR8 and BmR10) at 100, 200, 400 and 800 µg/mL. Two properly negative controls (distilled water and 2% methanol) and thiabendazole (100 µg/mL) as a positive control were used for each bioassay. The chemical identification of the extract, fractions and subfractions was performed through chromatographic processes like open column chromatography, thin-layer chromatography (TLC) and high-performance liquid chromatography (HPLC-PDA). Additionally, the GIN eggs exposed to the bioactive compounds were observed through confocal laser scanning microscopy (CLSM). The Bm-HAE showed 99.5% egg hatching inhibition (EHI) at 6,000 µg/mL with a lethal concentration (LC50) of 1110 µg/mL. The Bm-EtOAc fraction displayed 99.1% EHI at 800 µg/mL with LC50 = 180 µg/mL. The ovicidal activity of the four subfractions was similar at 800 µg/mL: BmR6 (92% EHI); BmR7 (100% EHI); BmR8 (97.8%); and BmR10 (99.1%). The HPLC-PDA analysis of the bioactive subfractions allowed identification of p-coumaric acid, ferulic acid and coumarin derivatives as major compounds. The CLSM analysis allowed observation of morphological alterations in unhatched larvae caused by bioactive compounds present in the Bm-EtOAc and BmR10. In addition, the flavonoids eriodyctiol, luteolin and cynaroside were described for the first time for B. montalvoana.

Can COVID-19 pandemic worsen previous neurological/psychiatric diseases?

Introduction: The SARS-CoV-2 pandemic has been affecting the world since January 2020. Although its pathogenesis is primarily directed to the respiratory tract, other organs may be affected, including the nervous system. It has also been shown that the social context (confinement, lack of treatment) has affected neurological patients during this period. The aim of the study it was to assess the subjective worsening of neurological/psychiatric diseases in the context of the SARS-Cov-2 pandemic. Methods: Three groups of neurological/psychiatric patients were included: Patients who had symptomatic COVID-19 (n = 89), patients who had asymptomatic COVID-19 (n = 40), and a control group (n = 47), consisting of neurological/psychiatric patients without a history of SARS-Cov-2 infection. Results: 30.7% of the included individuals considered that their basal pathology had worsened during the study period. This feeling was significantly more frequent (P = 0.01) in patients with symptomatic COVID-19 (39.3%) than in patients of the other 2 groups (21.8%). Worsening was not related to the severity of COVID-19. The neurological conditions that significantly worsened after COVID-19, comparing symptomatic COVID-19 with the other 2 groups, were demyelinating and degenerative diseases. Conclusions: These results confirmed the impact of the SARS-Cov-2 pandemic on patients with neurological/psychiatric diseases. Confinement, lack of medical care, and the threat of diagnosis are surely contributing factors. Although the finding of a higher frequency of worsening in symptomatic COVID-19 patients may be related to greater anxiety/depression in this group of patients, we cannot exclude the role of direct affectation of the nervous system by the virus or damage due to neuroinflammation.

Introducción: La pandemia por SARS-CoV-2 afecta al mundo desde enero de 2020. Aunque su patogenia se dirige principalmente a las vías respiratorias, otros órganos pueden verse afectados, incluido el sistema nervioso. También se ha demostrado que el contexto social (confinamiento, falta de tratamiento) ha afectado a los pacientes neurológicos durante este periodo. El objetivo del estudio fue evaluar el empeoramiento subjetivo de enfermedades neurológicas/psiquiátricas en el contexto de la pandemia por SARS-Cov-2. Métodos: Se incluyeron tres grupos de pacientes neurológicos/psiquiátricos: pacientes que tenían COVID-19 sintomático (n = 89), pacientes que tenían COVID-19 asintomático (n = 40) y un grupo control (n = 47), formado por pacientes neurológicos/psiquiátricos sin antecedentes de infección por SARS-Cov-2. Resultados: El 30,7% de los individuos incluidos consideró que su patología basal había empeorado durante el período de estudio. Este sentimiento fue significativamente más frecuente (p = 0,01) en pacientes con COVID-19 sintomático (39,3%) que en pacientes de los otros 2 grupos (21,8%). El empeoramiento no estuvo relacionado con la gravedad de COVID-19. Las condiciones neurológicas que empeoraron significativamente después de la COVID-19, comparando la COVID-19 sintomática con los otros 2 grupos, fueron las enfermedades desmielinizantes y degenerativas. Conclusiones: estos resultados confirmaron el impacto de la pandemia del SARS-Cov-2 en pacientes con enfermedades neurológicas/psiquiátricas. El encierro, la falta de atención médica y la amenaza del diagnóstico son seguramente factores contribuyentes. Aunque el hallazgo de una mayor frecuencia de empeoramiento en pacientes sintomáticos de COVID-19 puede estar relacionado con una mayor ansiedad/depresión en este grupo de pacientes, no podemos excluir el papel de la afectación directa del sistema nervioso por el virus o el daño por neuroinflamación.

Partially Dehulled Sunflower Seeds in Diets for Grazing Chickens: Effect in Meat Quality

The effect of including partially dehulled sunflower seeds in the diet of grazing chickens in meat quality was evaluated. Two hundred and forty, one-day-old, Ross 308 chickens were used, randomly distributed into four treatments with six replicates of 10 birds each. Seventy-two birds were slaughtered at seven weeks of age, 18 per treatment, extracting the Pectoralis major muscle to analyze meat quality. The treatments were completely randomized in a 2x2 factorial arrangement, where type of rearing (confinement or grazing) and diet (base diet or base diet substituting 10% soybean meal for partially dehulled sunflower seeds) were the independent variables. The grazing chickens spent 8 hours a day in a white clover (Trifolium repens) paddock. Including sunflower seeds improved (p<0.05) the color and crude protein (CP) in breast meat (p<0.05), while grazing increased (p<0.05) CP, dry mater (DM), and shear force (SF), and the percentage of breast fat decreased (p<0.05) by up to 50%. Additionally, grazing increased (p<0.05) saturated fatty acids (SFA) and reduced (p<0.05) lipid oxidation by up to 50%. Partially replacing soybean meal with partially dehulled sunflower seeds in the diet of grazing chickens with white clover improves the physicochemical characteristics and nutritional quality of the breast meat; it also decreases lipid oxidation, extending the shelf life of the meat.(AU)

Green Synthesis of Iron Oxides and Phosphates via Thermal Treatment of Iron Polyphenols Synthesized by a Camellia sinensis Extract.

Iron oxide nanoparticles (FeONPs) prepared with plant extracts have been emerging as green and sustainable materials. FeONPs are usually amorphous due to the chelation of the tea polyphenols (TPs) to the iron, and the real nature of the iron compounds is not completely understood. The main goal of this study was to investigate the behavior of the green FeONPs synthesized from an Fe3+ salt and Cammelia sinensis (black tea) extract upon thermal treatment, in order to remove TPs and enable the formation of crystalline materials suitable for a thorough characterization and with the potential for diverse applications. The as-prepared FeONPs were assigned as mixed-valence Fe(III) oxyhydroxides and Fe(II)/Fe(III) ions bound to TPs. A detailed description of the phase transformation upon heating revealed the formation of the rare nano ß-Fe2O3 phase at 400 °C, followed by a transformation to α-Fe2O3 as the temperature increased. Above 600 °C, the unprecedented formation of FePO4 and Fe3PO7 was observed, produced from the reaction of Fe2O3 and free phosphate ions present in the black tea leaves, Fe3PO7 being the major phase obtained at 900 °C. Finally, the catalytic potential of the FeONPs to treat the azo dye methyl orange through a heterogeneous Fenton-like system was investigated.

[Validated scales for neurorehabilitation in Hispanics: Scoping review]. / Escalas validadas para neurorrehabilitación en Hispanoamérica: revisión exploratoria.

In the area of health there are scales that allow collecting and analyzing conditions objectively. Its validation process includes translation from another language, semantic adaptation, and its application to measure its validity and reliability in an environment other than the original one. The objective of this review was to identify the instruments validated in Hispanics America in the literature and to know the psychometric properties in the field of neurorehabilitation. An exploratory review was carried out in the PubMed, PeDro, Scholar, Science Direct and LILACS databases, using combinations with «evaluation¼, «physical therapy¼, «rehabilitation¼, «Neurology¼. Of the 18,355 records retrieved, 105 received a full title and abstract reading; where finally 25 were included in the qualitative synthesis and critically appreciated. It is concluded that the scales presented here have good psychometric characteristics that allow their adoption in clinical and therapeutic processes.

Estimación de riesgo cardiovascular ateroesclerótico en pacientes adultos sin sospecha de cifras tensionales elevadas / Estimation of aterosclerotic cardiovascular risk in adult patients without a suspicion of having high pressure readings / Estimativa do risco cardiovascular aterosclerótico em pacientes adultos sem suspeita de níveis elevados de tensão arterial

RESUMEN Introducción: Las enfermedades cardiovasculares representan la primera causa de muerte en el mundo. La estimación del Riesgo Cardiovascular (RCV) podría disminuir la carga de la enfermedad y mejorar la calidad de vida de los pacientes. Objetivo: Estimar el RCV en pacientes sin sospecha de cifras tensionales elevadas en una Clínica de Medicina Familiar en la Ciudad de México. Métodos: Estudio transversal descriptivo, participaron 101 pacientes de sexo masculino y femenino, de 40 a 69 años, sin diagnóstico previo de Hipertensión Arterial (HTA), pero que presentaron cifras tensionales altas al momento del estudio. Para diagnosticar HTA se utilizaron los criterios de la Asociación Americana del Corazón-2017. El RCV se evaluó con el ASCVD-Risk Estimator Plus. Resultados: En la muestra la HTA estuvo presente en el 55.4 %, 44.6 % manifestaron presión arterial elevada. Respecto al RCV, 54.4 % presentaron bajo riesgo, 11.8 % riesgo límite, 25.7 % intermedio y 7.9 % alto. Los factores de RCV con mayor prevalencia fueron diabetes mellitus tipo 2 (DM2), sobrepeso, obesidad y elevación de cifras tensionales. Discusión: Un porcentaje importante de participantes presentó RCV en sus diferentes categorías. Se requiere ser más estrictos en los parámetros utilizados para definir la HTA; pues sin intervenciones oportunas las enfermedades cardiovasculares continuarán incrementándose. Conclusión: Cerca de la mitad de los casos presentaron un RCV de límite a alto. Existió alta prevalencia de factores de riesgo individuales como DM2, HTA y dislipidemia. Se deben fortalecer búsquedas intencionadas de pacientes con características similares a las de este estudio para prevenir el desarrollo de enfermedades cardiovasculares.

ABSTRACT Introduction: Cardiovascular diseases are the main cause of death in the world. The estimation of the Cardiovascular Risk (CVR) could both reduce the burden of the illness and improve the quality of life of the patients. Objective: To estimate the CVR in adult patients without a suspicion of having high pressure readings in a Clinic of Family Medicine in Mexico City. Methods: This is a descriptive and transversal study with a sample of 101 male and female patients in the range of 40 to 69 years old, who did not have a previous hypertension diagnosis but who, at the moment of this study, showed high tension readings. The American Heart Association 2017 criteria were used. The cardiovascular risk was assessed using the ASCVD-Risk Estimator Plus. Results: Arterial hypertension readings were found in 55.4 % of the sample. 54.4 % of the sample met the criteria for low risk, 11.8 % for limit risk, 25.7 % for medium risk, and 7.9 % for high risk. The most prevalent factors associated with cardiovascular risk were type 2 diabetes mellitus, overweight, obesity, and hypertension. Discussion: An important percentage of the sample showed cardiovascular risk to some degree, suggesting that perhaps using stricter parameters to define hypertension could prompt more timely interventions. Conclusion: Considering both the high percentage of participants who demonstrated having a cardiovascular risk of concern and the high prevalence of risk factors such as Type 2 Diabetes Mellitus, hypertension, and overweight, timely monitoring interventions should be promoted in order to prevent the development of cardiovascular diseases.

RESUMO Introdução: As doenças cardiovasculares representam a principal causa de morte a nível mundial. A estimativa do risco cardiovascular (RCV) poderia diminuir o peso da doença e melhorar a qualidade de vida dos pacientes. Objetivo: Estimar o RCV em pacientes sem suspeita de tensão arterial elevada em uma Clínica de Medicina Familiar na Cidade do México. Métodos: Um estudo descritivo transversal envolvendo 101 pacientes do sexo masculino e feminino com idades entre os 40 - 69 anos, sem diagnóstico prévio de hipertensão (HTA), mas com tensão arterial elevada no momento do estudo. Os critérios da American Heart Association-2017 foram utilizados para diagnosticar o HTA. O RCV foi avaliado utilizando o ASCVD-Risk Estimator Plus. Resultados: Na amostra, a HTA esteve presente em 55,4 %, 44,6 % reportou tensão arterial elevada. Em relação à RCV, 54,4 % apresentavam baixo risco, 11,8 % risco limite, 25,7 % risco intermédio e 7,9 % alto risco. Os fatores de RCV mais prevalentes foram a diabetes melito tipo 2 (DM2), excesso de peso, obesidade e tensão arterial elevada. Discussão: Uma percentagem significativa de participantes tinha RCV em diferentes categorias. Há necessidade de ser mais rigoroso nos parâmetros utilizados para definir a HTA; sem intervenções atempadas, as doenças cardiovasculares continuarão aumentando. Conclusão: Quase metade dos casos tinham um limite de RCV elevado. Havia uma elevada prevalência de fatores de risco individuais tais como DM2, hipertensão e dislipidemia. A procura intencional de pacientes com características semelhantes às deste estudo deve ser reforçada para prevenir o desenvolvimento de doenças cardiovasculares.

Trends of incidence, mortality and survival of multiple myeloma in Spain. A twenty-three-year population-based study.

BACKGROUND: Despite major advances, multiple myeloma remains an incurable disease. Epidemiological data from high-quality population-based registries are needed to understand the heterogeneous landscape of the disease. METHODS: Incidence, mortality and survival in multiple myeloma were comprehensively analyzed in the Girona and Granada population-based cancer registries, over a 23-year study (1994-2016), divided into three periods (1994-2001, 2002-2009 and 2010-2016). Joinpoint regression analysis was used to estimate the annual percentage change in incidence and mortality. Age-standardized net survival was calculated with the Pohar-Perme method. RESULTS: 1957 myeloma patients were included in the study, with a median age of 72 years. Age-standardized incidence and mortality rates decreased over time in both sexes and both rates were higher in males. Five-year age-standardized net survival by period was 27.4% (1994-2001), 38.8% (2002-2009), and 47.4% (2010-2016). Survival improved for all age groups: 32.4%, 74.1% and 78.5% for patients aged 15-49; 27.5%, 44.6%, and 58.5% for those aged 50-69; finally, 24.8%, 25.5%, and 26.3% for the older group. CONCLUSION: Incidence remained overall stable throughout the study, with only a small increase for men. Mortality was progressively decreasing in both sexes. Both incidence and mortality were higher in men. Age plays a critical role in survival, with impressive improvement in patients younger than 70 years, but only a minor benefit in those older than 70.

[Model of care for the treatment of patients with osteoarthritis from the first to the third level]. / Modelo de atención para el tratamiento de pacientes con osteoartritis del primer al tercer nivel.

INTRODUCTION: Osteoarthritis in Mexico is one of the ten most frequent causes of disability. Early diagnosis and detection of risk factors are determinant for treatment. The institutional organization establishes therapeutic guidelines according to each level of care, but effective management is not achieved. MATERIAL AND METHODS: A prospective, pilot, interventional, clinical study was conducted, which included patients diagnosed with different degrees of knee osteoarthritis in the first, second and third level of care, with an integrative model that includes a group of professionals for the intervention of nutritional, physiotherapeutic, social and psychological evaluation from the first level. RESULTS: The intervention of a multidisciplinary care group allows a correct evaluation and assignment of the level of care, optimizing human and material resources. The participation of different disciplines in nutrition, psychology, social work, physiotherapy and rehabilitation modifies the global lifestyle by involving the patients themselves in their treatment. The intervention group had improvements in the visual analog pain scale, mobility arcs, low body mass index and improvement in the psychological aspect. CONCLUSIONS: The proposed model of care demonstrates that implementation in the institution and in each clinical care unit should be considered to improve outcomes.

INTRODUCCIÓN: La osteoartritis en México es una de las 10 causas más frecuentes de discapacidad. El diagnóstico temprano y la detección de factores de riesgo son determinantes para el tratamiento. La organización institucional establece las pautas terapéuticas de acuerdo con cada nivel de atención, pero no se logra un manejo efectivo. MATERIAL Y MÉTODOS: Se realizó un estudio prospectivo, piloto, de intervención, clínico conformado por pacientes diagnosticados con diferentes grados de osteoartritis de rodilla en el primer, segundo y tercer nivel de atención, con un modelo integrador que incluyó un grupo de profesionales para la intervención de la evaluación nutricional, fisioterapéutica, social y sicológica desde el primer nivel. RESULTADOS: La intervención de un grupo de atención multidisciplinaria permite una correcta evaluación y asignación del nivel de atención optimizando los recursos humanos y materiales. La participación de diferentes disciplinas en nutrición, sicología, trabajo social, fisioterapia y rehabilitación modifica el estilo de vida global al involucrar a los propios pacientes en su tratamiento. El grupo de intervención tuvo mejoras en la escala de dolor análogo visual, arcos de movilidad, bajo índice de masa corporal y mejoría en el aspecto sicológico. CONCLUSIONES: El modelo de atención propuesto demuestra que la implementación en la institución y en cada unidad clínica de atención debe considerarse para mejorar los resultados.

La auscultación pulmonar en el siglo 21 / Lung auscultation in the 21th century

La auscultación pulmonar es parte fundamental del examen físico para el diagnóstico de las enfermedades respiratorias. La estandarización que ha alcanzado la nomenclatura de los ruidos respiratorios, sumado a los avances en el análisis computacional de los mismos, han permitido mejorar la utilidad de esta técnica. Sin embargo, el rendimiento de la auscultación pulmonar ha sido cuestionado por tener una concordancia variable entre profesionales de la salud. Aun cuando la incorporación de nuevas herramientas diagnósticas de imágenes y función pulmonar han revolucionado la precisión diagnóstica en enfermedades respiratorias, no existe tecnología que permita reemplazar la técnica de auscultación pulmonar para guiar el proceso diagnóstico. Por una parte, la auscultación pulmonar permite seleccionar a aquellos pacientes que se beneficiarán de una determinada técnica diagnóstica, se puede repetir cuantas veces sea necesario para tomar decisiones clínicas, y frecuentemente permite prescindir de exámenes adicionales que no siempre son fáciles de realizar o no se encuentran disponibles. En esta revisión se presenta el estado actual de la técnica de auscultación pulmonar y su rendimiento objetivo basado en la nomenclatura actual aceptada para los ruidos respiratorios, además de resumir la evidencia principal de estudios de concordancia de auscultación pediátrica y su análisis objetivo a través de nueva tecnología computacional.

Lung auscultation is an essential part of the physical examination for diagnosing respiratory diseases. The terminology standardization for lung sounds, in addition to advances in their analysis through new technologies, have improved the use of this technique. However, traditional auscultation has been questioned due to the limited concordance among health professionals. Despite the revolu tionary use of new diagnostic tools of imaging and lung function tests allowing diagnostic accuracy in respiratory diseases, no technology can replace lung auscultation to guide the diagnostic process. Lung auscultation allows identifying those patients who may benefit from a specific test. Moreover, this technique can be performed many times to make clinical decisions, and often with no need for- complicated and sometimes unavailable tests. This review describes the current state-of-the-art of lung auscultation and its efficacy based on the current respiratory sound terminology. In addition, it describes the main evidence on respiratory sound concordance studies among health professionals and its objective analysis through new technology.

Media preferences, micro-morphometric analysis, and cardinal growth temperature determination for Phytophthora infestans sensu lato isolated from different hosts in Colombia / Preferências de mídia, análise micro-morfométricos e determinação da temperature cardeal de crescimento para Phytophthora infestans sensu lato isolada de diferentes hospedeiros na Colômbia

Abstract During the last years Phytophthora infestans sensu lato (Mont. De Bary) has caused epidemics in Colombia in Andean fruit crops such as Solanum quitoense and Solanum betaceum. Establishment of new or modified experimental procedures to study this pathogen is a mandatory subject for scientists. Twelve isolates of Phytophthora spp. obtained from six different Solanum hosts in Colombia were used to evaluate the effect of five different solid media for growth and ability to produce sporangia and liberate zoospores. Determination of the best media culture and optimal growth temperature were necessary to perform measurements and correlate the provenance of isolates with phenotypic traits. Modifications were made to use ingredients available in local markets on the following media: lime bean agar (LBA), Tree tomato or tree tomato agar (TA), carrot agar (AZ), Rye A modified agar and 32% non-clarified V8 agar. Cardinal temperature determination was performed at 10, 15, 20, and 25 °C. Morphometric traits were measured once the optimal media culture and temperature were defined. Correlation analysis showed that there is a relationship between the host and isolate's preferences for media culture and optimal growth temperature. In addition, the production of characteristic sporangia, sporangiophore and mycelia was related with the media type used and host from which the isolate was collected. In this work useful information was provided to make studies about the biology and development of isolates gathered from cultivated and wild non-traditional hosts.

Resumo Durante os últimos anos Phytophthora infestans sensu lato causou epidemias na Colômbia em lavouras de frutos andinos, como Solanum quitoense e Solanum betaceum. Estabelecimento de procedimentos experimentais novos ou modificados para estudar este patógeno é um assunto obrigatório para os cientistas. Doze isolados de Phytophthora spp. obtidos de seis diferentes hosts Solanum na Colômbia foram usados para avaliar o efeito de cinco diferentes mídias sólidas para o crescimento e a capacidade de produzir esporângios e libertar zoósporos. Determinação da melhor cultura de mídia e temperatura de crescimento ideal foram necessárias para realizar medições e correlacionar a proveniência de isolados com traços fenotípica. Foram feitas modificações para usar os ingredientes disponíveis nos mercados locais nos seguintes meios: ágar do feijão de cal (LBA), tomate da árvore ou ágar do tomate da árvore (TA), ágar da cenoura (AZ), centeio um ágar modificado e 32% de ágar-V8 não-esclarecido. A determinação da temperatura Cardeal foi realizada em 10, 15, 20 e 25 °C. Traços morfométricos foram medidos uma vez que a cultura de mídia ideal e temperatura foram definidos. Análise de correlação mostrou que há uma relação entre o hospedeiro e isolar as preferências para a cultura de mídia e temperatura de crescimento ideal. Além disso, a produção de esporângios característica, esporangióforo e mycelia foi relacionada com o tipo de mídia utilizado e hospedeiros a partir do qual o isolado foi coletado. Neste trabalho foram fornecidas informações úteis para fazer estudos sobre a biologia e o desenvolvimento de isolados recolhidos de hospedeiros não-tradicionais cultivados e selvagens.

Media preferences, micro-morphometric analysis, and cardinal growth temperature determination for Phytophthora infestans sensu lato isolated from different hosts in Colombia / Preferências de mídia, análise micro-morfométricos e determinação da temperature cardeal de crescimento para Phytophthora infestans sensu lato isolada de diferentes hospedeiros na Colômbia

During the last years Phytophthora infestans sensu lato (Mont. De Bary) has caused epidemics in Colombia in Andean fruit crops such as Solanum quitoense and Solanum betaceum. Establishment of new or modified experimental procedures to study this pathogen is a mandatory subject for scientists. Twelve isolates of Phytophthora spp. obtained from six different Solanum hosts in Colombia were used to evaluate the effect of five different solid media for growth and ability to produce sporangia and liberate zoospores. Determination of the best media culture and optimal growth temperature were necessary to perform measurements and correlate the provenance of isolates with phenotypic traits. Modifications were made to use ingredients available in local markets on the following media: lime bean agar (LBA), Tree tomato or tree tomato agar (TA), carrot agar (AZ), Rye A modified agar and 32% non-clarified V8 agar. Cardinal temperature determination was performed at 10, 15, 20, and 25 °C. Morphometric traits were measured once the optimal media culture and temperature were defined. Correlation analysis showed that there is a relationship between the host and isolate's preferences for media culture and optimal growth temperature. In addition, the production of characteristic sporangia, sporangiophore and mycelia was related with the media type used and host from which the isolate was collected. In this work useful information was provided to make studies about the biology and development of isolates gathered from cultivated and wild non-traditional hosts.(AU)

Durante os últimos anos Phytophthora infestans sensu lato causou epidemias na Colômbia em lavouras de frutos andinos, como Solanum quitoense e Solanum betaceum. Estabelecimento de procedimentos experimentais novos ou modificados para estudar este patógeno é um assunto obrigatório para os cientistas. Doze isolados de Phytophthora spp. obtidos de seis diferentes hosts Solanum na Colômbia foram usados para avaliar o efeito de cinco diferentes mídias sólidas para o crescimento e a capacidade de produzir esporângios e libertar zoósporos. Determinação da melhor cultura de mídia e temperatura de crescimento ideal foram necessárias para realizar medições e correlacionar a proveniência de isolados com traços fenotípica. Foram feitas modificações para usar os ingredientes disponíveis nos mercados locais nos seguintes meios: ágar do feijão de cal (LBA), tomate da árvore ou ágar do tomate da árvore (TA), ágar da cenoura (AZ), centeio um ágar modificado e 32% de ágar-V8 não-esclarecido. A determinação da temperatura Cardeal foi realizada em 10, 15, 20 e 25 °C. Traços morfométricos foram medidos uma vez que a cultura de mídia ideal e temperatura foram definidos. Análise de correlação mostrou que há uma relação entre o hospedeiro e isolar as preferências para a cultura de mídia e temperatura de crescimento ideal. Além disso, a produção de esporângios característica, esporangióforo e mycelia foi relacionada com o tipo de mídia utilizado e hospedeiros a partir do qual o isolado foi coletado. Neste trabalho foram fornecidas informações úteis para fazer estudos sobre a biologia e o desenvolvimento de isolados recolhidos de hospedeiros não-tradicionais cultivados e selvagens.(AU)

Pre-exposure prophylaxis and its implications in Mexico: notions of men who have sex with men.

Background The aim of this study was to analyse ideas regarding pre-exposure prophylaxis (PrEP) for the prevention of HIV among groups of men who have sex with men in Mexico for future implementation in health services. METHODS: During 2015, 54 people participated in four focus groups in three Mexican cities. Issues related to challenges for uses and limitations of PrEP were explored. RESULTS: In contrast with other qualitative studies, which emphasised problems with relationships with other people for PrEP use or access to key populations, Mexican participants focused their concerns around the public health services organisation: PrEP is too expensive and the health services have no resources, which will affect services and result in discrimination. Participants identified possible stigmatisation related to prejudices of medical providers who do not approve the decreased use of condoms. As a potential solution, participants suggested that the Mexican Government could negotiate a lower cost for PrEP and public health services could provide the medication, with periodical review of the arrangements by civil organisations. CONCLUSION: In the current context of the new Mexican government, it is necessary to propose public politics focused on negotiating with pharmaceutical companies on the costs of the PrEP, coordinating public services with groups within civil society and strengthening policies and actions to reduce stigma and discrimination.

[Lung auscultation in the 21th century]. / La auscultación pulmonar en el siglo 21.

Lung auscultation is an essential part of the physical examination for diagnosing respiratory diseases. The terminology standardization for lung sounds, in addition to advances in their analysis through new technologies, have improved the use of this technique. However, traditional auscultation has been questioned due to the limited concordance among health professionals. Despite the revolu tionary use of new diagnostic tools of imaging and lung function tests allowing diagnostic accuracy in respiratory diseases, no technology can replace lung auscultation to guide the diagnostic process. Lung auscultation allows identifying those patients who may benefit from a specific test. Moreover, this technique can be performed many times to make clinical decisions, and often with no need for- complicated and sometimes unavailable tests. This review describes the current state-of-the-art of lung auscultation and its efficacy based on the current respiratory sound terminology. In addition, it describes the main evidence on respiratory sound concordance studies among health professionals and its objective analysis through new technology.

Media preferences, micro-morphometric analysis, and cardinal growth temperature determination for Phytophthora infestans sensu lato isolated from different hosts in Colombia.

During the last years Phytophthora infestans sensu lato (Mont. De Bary) has caused epidemics in Colombia in Andean fruit crops such as Solanum quitoense and Solanum betaceum. Establishment of new or modified experimental procedures to study this pathogen is a mandatory subject for scientists. Twelve isolates of Phytophthora spp. obtained from six different Solanum hosts in Colombia were used to evaluate the effect of five different solid media for growth and ability to produce sporangia and liberate zoospores. Determination of the best media culture and optimal growth temperature were necessary to perform measurements and correlate the provenance of isolates with phenotypic traits. Modifications were made to use ingredients available in local markets on the following media: lime bean agar (LBA), Tree tomato or tree tomato agar (TA), carrot agar (AZ), Rye A modified agar and 32% non-clarified V8 agar. Cardinal temperature determination was performed at 10, 15, 20, and 25 °C. Morphometric traits were measured once the optimal media culture and temperature were defined. Correlation analysis showed that there is a relationship between the host and isolate's preferences for media culture and optimal growth temperature. In addition, the production of characteristic sporangia, sporangiophore and mycelia was related with the media type used and host from which the isolate was collected. In this work useful information was provided to make studies about the biology and development of isolates gathered from cultivated and wild non-traditional hosts.

Corrigendum to "Identifying cloud forest conservation areas in Mexico from the potential distribution of 19 representative species" [Heliyon 5 (3) (March 2019) e01423].

[This corrects the article DOI: 10.1016/j.heliyon.2019.e01423.].

Identifying cloud forest conservation areas in Mexico from the potential distribution of 19 representative species.

Cloud forest is a sensitive and vulnerable ecosystem that is threatened by human activities as well as climate change. Previous studies have shown how transitional ecosystems such as cloud forests will be the most negatively impacted by the global increase in temperature. Therefore, the niche modeling framework was used in this study to geographically identify the areas with the climatic potential to host the largest number of key tree species in this ecosystem and to propose them as priority conservation areas. A total of 19 species were modeled using the MaxEnt algorithm; binary maps were generated for each species and combined to produce one potential suitability map and identify climatic priority areas. Thus, 7% of the national area of Mexico shows suitability for the cloud forest ecosystem, although it is currently distributed in less than 1% of the country. Finally, potential suitability areas were compared with natural protected areas, current land use and priority conservation areas. We found that of the current suitable area, only 5% coincides with some federal or state protection regime. Natural protected areas have proven to be a mechanism for forest conservation, so we must consider increasing the number and area of those protected areas that favor the conservation of these key cloud forest species.

Epidemiology and natural history of cutaneous squamous cell carcinoma in recessive dystrophic epidermolysis bullosa patients: 20 years' experience of a reference centre in Spain.

BACKGROUND: Cutaneous squamous cell carcinoma (cSCC) is the leading cause of death in patients with recessive dystrophic epidermolysis bullosa (RDEB). We provide the management and prognosis of cSCC in RDEB patients at a Spanish reference center. MATERIALS AND METHODS: We retrospectively included patients with RDEB attended in La Paz University Hospital from November 1988 to October 2018. RESULTS: Fourteen patients developed at least one cSCC. Tumors were predominantly well differentiated. Nearly half of the tumors have recurred. Median time to first recurrence was 23.4 months (95% CI: 17.2-29.5). Five patients have developed distant metastases. Median overall survival (mOS) was 136.5 months since the diagnosis of the first cSCC (95% CI: 30.6-242.3). When distant metastases occurred, mOS was 6.78 months (95% CI: 1.94-11.61). CONCLUSIONS: cSCC is a life-threatening complication of RDEB patients. Although tumors are usually well differentiated, they tend to relapse. This is the first Spanish report of cSCC arising in RDEB patients.